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Journal articles on the topic 'Long-term Cancer Survivors'

Author: Grafiati

Published: 4 June 2021

Last updated: 13 February 2022

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1

Mehta, Rutika, Rohit Jain, Lori Rhodes, Joseph Abraham, and Kenneth David Miller. "Long-term cancer survivorship care: On the radar screen?" Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e20567-e20567. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e20567.

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e20567 Background: Long-term cancer survivors require comprehensive care. The purpose of this study was to describe how survivorship care fits into oncologists’ clinical time, and characterize long-term cancer survivors’ problems and oncology follow-up care. Methods: We abstracted 18,882 medical records of unique cancer patient visits during 2010 at a major NCI-designated cancer center and then evaluated survivor care for one week in April, 2010 to characterize how oncologists spend their clinical time. Finally, we selected three subgroups from the survivor population (n≈100 each) of survivors at 1-5 years, 6-10 years, and >10 years after diagnosis. We collected demographic data, purpose of visit, cancer-specific information, late and long-term effects, and type of care delivered, including surveillance for recurrence, intervention, prevention, and coordination of care. Results: In the larger group of 18,882, only 14% of survivors were more than 10 years post-diagnosis. Approximately two-thirds of the survivors were women. Breast cancer survivors comprised 38%, and survivors of hematologic malignancies accounted for 21% of the population. During the one week studied, the majority of oncologists' patients (74%) were actively receiving treatment; only 5% of their patients were 5 or more years post-diagnosis. Second or secondary malignancies were noted in 8% of patients. Late and long-term effects were uncommon. Approximately 25% of survivors beyond five years were observed to have late effects due to cancer treatment, most common being fatigue, neurological endocrine, and cardiac. Of the 300 selected survivors, sixty-two percent received only surveillance care during their visit. Only 3% of these patients received an entire array of survivorship care that included surveillance, intervention, co-ordination and prevention. Conclusions: A small proportion of oncologists’ visits were with long-term cancer survivors (5-14%) of whom only 25% had late or long-term effects of cancer treatment so overall very few of office visits were with long-term survivors who had late and long-term complications. All visits involved surveillance for cancer recurrence but there was little focus on prevention, intervention, and coordination of care for cancer survivors.

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2

Ekenga, Christine C., Eunsun Kwon, BoRin Kim, and Sojung Park. "Long-Term Employment Outcomes among Female Cancer Survivors." International Journal of Environmental Research and Public Health 17, no. 8 (April 16, 2020): 2751. http://dx.doi.org/10.3390/ijerph17082751.

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Advances in early detection and treatment have led to a growing population of female cancer survivors, many of whom are of working age. We examined the relationship between cancer and long-term (>5 years) employment outcomes in a nationally representative sample of working-age women in the United States. Data from nine waves of the Health and Retirement Study were used to examine employment status and weekly hours worked among cancer survivors (n = 483) and women without cancer (n = 6605). We used random slope regression models to estimate the impact of cancer and occupation type on employment outcomes. There was no difference in employment status between cancer survivors and women without cancer at baseline; however, during follow-up, cancer survivors were more likely to be employed than women without cancer (odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.11–1.58). Among 6–10-year survivors, professional workers were less likely (OR = 0.40, 95% CI: 0.21–0.74) to be employed than manual workers. Among >10-year survivors, professional workers averaged fewer weekly hours worked (−2.4 h, 95% CI: −4.4–−0.47) than manual workers. The impact of cancer on long-term employment outcomes may differ by occupation type. Identifying the occupation-specific mechanisms associated with the return to work will be critical to developing targeted strategies to promote employment in the growing female cancer survivor population.

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3

Quant, E. C., M. Silver, S. Yip, P. Ryg, K. Provencher, K. McCormack, D. N. Louis, R. Betensky, C. Nutt, and T. T. Batchelor. "Case-control study of long-term survivors of glioblastoma." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e13021-e13021. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e13021.

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e13021 Background: Survival of patients with glioblastoma (GBM) remains poor. However, a small percentage of GBM patients live ≥ 3 years. Relatively little is known about the patterns of care and outcomes of these long term survivors relative to GBM patients with standard or short-term survival. Methods: Nested case-control study of long term survivors (≥ 36 months), short term survivors (≤ 6 months) and standard survivors (> 6 months but < 36 months). Pathology was confirmed in all study subjects by a single neuropathologist. Each long term survivor (LTS) was matched to a short term survivor (STS) and 3 standard survivors (SS) by the well-established prognostic factors, age and postoperative Karnofsky Performance Status. Clinical characteristics, treatment regimens and outcomes were reviewed. Conditional logistic regression models were used to assess potential associations between baseline factors and the probability of long or short term survival. Results: Matching yielded 23 LTS with 23 STS and 69 SS. Patient characteristics are summarized in the table below. Conclusions: Controlling for the well-established prognostic factors of age and performance status, long-term GBM survivors differed significantly from short-term GBM survivors based on tumor location and extent of resection. However, there were no significant differences in baseline factors between long-term survivors versus standard survivors in this analysis. Short-term GBM survivors differed from standard survivors by tumor location and extent of resection. Molecular factors are being assessed in these groups as potential contributors to these survival differences. [Table: see text] [Table: see text]

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4

Rajotte, Emily Jo, Leslie Heron, Karen Leslie Syrjala, and Kevin Scott Baker. "Health care utilization among long-term cancer survivors." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 22. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.22.

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22 Background: Survivors of adult cancer face lifetime health risks that are dependent on their cancer, cancer treatment exposures, comorbid health conditions, and lifestyle behaviors. A shared care model, including planned and formal transition of the cancer survivor from the oncologist to the primary care physician needs to be established to ensure appropriate care. Methods: As a LIVESTRONG Survivorship Center of Excellence Network member, the Survivorship Program at the Fred Hutchinson Cancer Research Center has established an outpatient clinic at the Seattle Cancer Care Alliance to meet the clinical needs of cancer survivors. Before their survivorship-focused clinic appointment, adult cancer survivors are asked to complete a comprehensive survey that includes questions on health care utilization. Results: Between August 2013 to December 2014, 142 clinic patients completed the survey. They were 70.4% female, mean age 48 years (SD 16.3, range 22-83) and 21.1% breast cancer, 30.2% leukemia/lymphoma, and 17.6% reproductive cancer survivors. Patients were a mean of 7.8 years (SD 9.5, range 0-43) from their cancer diagnosis at the time of clinic appointment. 70.4% reported receiving oncology care and 87.3% primary care within the 12 months before their survivorship visit. Forty percent reported more than 12 clinic visits in the past year in which they saw a physician, nurse practitioner or physician assistant compared with 6.5 clinic visits in the general population based on CDC, National Health Care Survey reference data. 41.5% had one or more visits to a hospital emergency or urgent care facility within the last year, compared with 39.4% in the CDC NHCS survey. Conclusions: Cancer survivors seen in a Survivorship Clinic utilize healthcare at a much higher rate than the general population. A shared-care model for cancer survivors, including a delineation of roles and specific points of communication, between the oncologist and the primary care physician may help address issues surrounding over-utilization. A cancer treatment summary and a survivorship care plan may be valuable tools to facilitate this shared care approach.

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5

Daly, Corinne, Elisabeth M. Del Giudice, Rinku Sutradhar, Lawrence Frank Paszat, Drew Wilton, Linda Rabeneck, and Nancy N. Baxter. "Follow-up of long-term young breast cancer survivors." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 8. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.8.

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8 Background: Evidence suggests breast cancer patients can be offered follow-up by family physician without concern of important recurrence–related serious clinical events occurring more frequently or quality of life being negatively affected. This study describes population-based patterns of follow-up care in 5-year recurrence-free young breast cancer survivors to determine factors influencing continued oncology follow-up in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study using cancer registry and administrative data. Women diagnosed with an incident breast cancer aged 20-44 between 1992 and 1999, survived for at least 5 years and recurrence-free for 5 years past diagnosis were identified in the Ontario Cancer Registry. Each survivor was matched to 5 control women with the same calendar year of birth and place of residence in Ontario. We determined outpatient physician visits with primary care, medical, radiation and surgical oncology physicians to investigate trends associated with increasing survivorship and compared visit rates to controls. We used negative binomial regression to investigate factors predicting high utilization of oncology services among survivors after 5-year recurrence survival. Results: We identified 4,581 survivors and 22,898 controls. By year 10, 51% breast cancer survivors were still being followed by an oncologist. In the survivors, fewer physician visits were observed among recurrence-free breast cancer survivors as time increased from diagnosis (Visit Rate Ratio [VRR] =0.95, 95% CI: 0.94, 0.96). Breast cancer survivors diagnosed from 1992-1995 had a higher rate of physician visits than those diagnosed from 1996-1999 (VRR = 1.16, 95% CI: 1.07, 1.25). More oncologist visits were associated with patients visiting a female oncologist (VRR = 1.20, 95% CI: 1.09, 1.33) and fewer visits were associated with patients visiting an oncologist who practiced outside of a regional cancer center (VRR = 0.67, 95% CI: 0.58, 0.77). Conclusions: Oncology visits of young breast cancer survivors after 5-year survival were associated with oncologist factors indicating that prolonged oncology follow-up in breast cancer survivors may be driven by practice patterns rather than patients’ needs.

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6

Schumacher, J. R., W. P. Witt, M. Palta, N. K. LoConte, S. M. Heidrich, A. Trentham-Dietz, N. Pandhi, and M. A. Smith. "Cancer Screening of Long-Term Cancer Survivors." Journal of the American Board of Family Medicine 25, no. 4 (July 1, 2012): 460–69. http://dx.doi.org/10.3122/jabfm.2012.04.110118.

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7

Marina, Neyssa. "LONG-TERM SURVIVORS OF CHILDHOOD CANCER." Pediatric Clinics of North America 44, no. 4 (August 1997): 1021–42. http://dx.doi.org/10.1016/s0031-3955(05)70543-5.

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8

Raber, Martin N. "Long-Term Fatigue in Cancer Survivors." Breast Diseases: A Year Book Quarterly 19, no. 1 (April 2008): 21–23. http://dx.doi.org/10.1016/s1043-321x(08)80003-3.

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9

Kardosh, Adel, Daphne Y. Lichtensztajn, Matthew A. Gubens, Pamela L. Kunz, George A. Fisher, and Christina A. Clarke. "Long-Term Survivors of Pancreatic Cancer." Pancreas 47, no. 8 (September 2018): 958–66. http://dx.doi.org/10.1097/mpa.0000000000001133.

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10

Ellingson, Laura L., and Kristian G. E. Borofka. "Long-Term Cancer Survivors’ Everyday Embodiment." Health Communication 35, no. 2 (November 22, 2018): 180–91. http://dx.doi.org/10.1080/10410236.2018.1550470.

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11

Pollack, Lori A., Walter Adamache, A. Blythe Ryerson, Christie R. Eheman, and Lisa C. Richardson. "Care of long-term cancer survivors." Cancer 115, no. 22 (August 14, 2009): 5284–95. http://dx.doi.org/10.1002/cncr.24624.

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12

Dixon, J. M., D. L. Page, T. J. Anderson, D. Lee, R. A. Elton, H. J. Stewart, and A. P. M. Forrest. "Long-term survivors after breast cancer." British Journal of Surgery 72, no. 6 (June 1985): 445–48. http://dx.doi.org/10.1002/bjs.1800720614.

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13

Carter, Barbara J. "Long-term survivors of breast cancer." Cancer Nursing 16, no. 5 (October 1993): 354???361. http://dx.doi.org/10.1097/00002820-199310000-00003.

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14

Tamboli, Cyrus P. "Long-Term Survivors of Testicular Cancer." Journal of Clinical Oncology 21, no. 20 (October 15, 2003): 3888. http://dx.doi.org/10.1200/jco.2003.99.110.

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15

Wagner, Hans Peter. "Long-term survivors of childhood cancer." Supportive Care in Cancer 9, no. 7 (August 24, 2001): 473–74. http://dx.doi.org/10.1007/s005200100305.

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16

Senger, Donna, J. Gregory Cairncross, and Peter A. J. Forsyth. "Long-Term Survivors of Glioblastoma." Cancer Journal 9, no. 3 (May 2003): 214–21. http://dx.doi.org/10.1097/00130404-200305000-00009.

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17

Nathan, Paul C., Mark L. Greenberg, Kirsten K. Ness, Melissa M. Hudson, Ann C. Mertens, Martin C. Mahoney, James G. Gurney, et al. "Medical Care in Long-Term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study." Journal of Clinical Oncology 26, no. 27 (September 20, 2008): 4401–9. http://dx.doi.org/10.1200/jco.2008.16.9607.

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Purpose To evaluate whether childhood cancer survivors receive regular medical care focused on the specific morbidities that can arise from their therapy. Patients and Methods We conducted a cross-sectional survey of health care use in 8,522 participants in the Childhood Cancer Survivor Study, a multi-institutional cohort of childhood cancer survivors. We assessed medical visits in the preceding 2 years, whether these visits were related to the prior cancer, whether survivors received advice about how to reduce their long-term risks, and whether screening tests were discussed or ordered. Completion of echocardiograms and mammograms were assessed in patients at high risk for cardiomyopathy or breast cancer. We examined the relationship between demographics, treatment, health status, chronic medical conditions, and health care use. Results Median age at cancer diagnosis was 6.8 years (range, 0 to 20.9 years) and at interview was 31.4 years (range, 17.5 to 54.1 years). Although 88.8% of survivors reported receiving some form of medical care, only 31.5% reported care that focused on their prior cancer (survivor-focused care), and 17.8% reported survivor-focused care that included advice about risk reduction or discussion or ordering of screening tests. Among survivors who received medical care, those who were black, older at interview, or uninsured were less likely to have received risk-based, survivor-focused care. Among patients at increased risk for cardiomyopathy or breast cancer, 511 (28.2%) of 1,810 and 169 (40.8%) of 414 had undergone a recommended echocardiogram or mammogram, respectively. Conclusion Despite a significant risk of late effects after cancer therapy, the majority of childhood cancer survivors do not receive recommended risk-based care.

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Paci, Eugenio, Angelo Cariddi, Alessandro Barchielli, Simonetta Bianchi, Gaetano Cardona, Vito Distante, Daniela Giorgi, Paolo Pacini, Marco Zappa, and Marco Rosselli Del Turco. "Long-Term Sequelae of Breast Cancer Surgery." Tumori Journal 82, no. 4 (July 1996): 321–24. http://dx.doi.org/10.1177/030089169608200405.

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Background Quality of care is today a major issue in oncology, and much attention is given to research on the outcome of breast cancer care. Too little attention has been devoted in the scientific literature to the consequences of treatment in long-term survivors, and in particular to the possible side effects. The specific aim of this contribution is to present population-based data about the long-term impact of breast cancer care in women who had an incident cancer in 1985/1986. Patients and Methods The cases are 476 breast cancers incident in the City of Florence in 1985-86. Women still living 5 years later were invited to have an interview and a physical examination. Lymphedema, peripheral nerve lesions and damage to the shoulder were assessed. Results Of the 346 5-year survivors, 238 accepted our invitation: 35.2% of the women reported some early postoperative sequelae, 30.2% had a chronic lymphedema and 18.9% a shoulder deficit. Comparing breast-conserving surgery with radical mastectomy, the risk of chronic lymphedema (OR=1.62; 95% CI: 0.91-2.88) and other lesions was higher for women who had a radical surgery. Women who had a breast-conserving surgery more often reported an early lymphedema (OR=1.60; 95% CI: 0.88-2.88). Conclusions The proportion of women who complained of (or manifested at the physical examination) a minor or major disability of the arm in our study was high. The impact of these functional problems in terms of quality of life should also be assessed, but it is our impression that there is need for much greater attention to the issue of long-term survivor sequelae.

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Chemaitilly, Wassim, and Charles A. Sklar. "Endocrine complications in long-term survivors of childhood cancers." Endocrine-Related Cancer 17, no. 3 (September 2010): R141—R159. http://dx.doi.org/10.1677/erc-10-0002.

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Endocrine disturbances are among the most frequently reported complications in childhood cancer survivors, affecting between 20 and 50% of individuals who survive into adulthood. Most endocrine complications are the result of prior cancer treatments, especially radiotherapy. The objective of the present review is to discuss the main endocrine complications observed in this population, including disorders of the hypothalamic–pituitary axis, disorders of pubertal development, thyroid dysfunction, gonadal dysfunction, decreased bone mineral density, obesity, and alterations in glucose metabolism with a special focus on recent findings reported from the Childhood Cancer Survivor Study.

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Rebholz, Cornelia E., Raoul C. Reulen, Andrew A. Toogood, Clare Frobisher, Emma R. Lancashire, David L. Winter, Claudia E. Kuehni, and Michael M. Hawkins. "Health Care Use of Long-Term Survivors of Childhood Cancer: The British Childhood Cancer Survivor Study." Journal of Clinical Oncology 29, no. 31 (November 1, 2011): 4181–88. http://dx.doi.org/10.1200/jco.2011.36.5619.

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Purpose Survivors of childhood cancer are at high risk of chronic conditions, but few studies investigated whether this translates into increased health care utilization. We compared health care service utilization between childhood cancer survivors and the general British population and investigated potential risk factors. Methods We used data from the British Childhood Cancer Survivor Study, a population-based cohort of 17,981 individuals diagnosed with childhood cancer (1940-1991) and surviving ≥ 5 years. Frequency of talks to a doctor, hospital outpatient visits, and day-patient and inpatient hospitalizations were ascertained by questionnaire in 10,483 survivors and were compared with the General Household Survey 2002 data by using logistic regression. Results Among survivors, 16.5% had talked to a doctor in the last 2 weeks, 25.5% had attended the outpatient department of a hospital in the last 3 months, 11.9% had been hospitalized as a day patient in the last 12 months, and 9.8% had been hospitalized as an inpatient in the last 12 months. Survivors had talked slightly more often to a doctor than the general population (odds ratio [OR], 1.2; 95% CI, 1.1 to 1.3) and experienced increased hospital outpatient visits (OR, 2.5; 95% CI, 2.3 to 2.8), day-patient hospitalizations (OR, 1.4; 95% CI, 1.3 to 1.6) and inpatient hospitalizations (OR, 1.9; 95% CI, 1.7 to 2.2). Survivors of Hodgkin's lymphoma, neuroblastoma, and Wilms tumor had the highest ORs for day-patient care, whereas survivors of CNS tumors and bone sarcomas had the highest OR for outpatient and inpatient care. The OR of health care use did not vary significantly with age of survivor. Conclusion We have quantified how excess morbidity experienced by survivors of childhood cancer translates into increased use of health care facilities.

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Tisnado, Diana, Neil Steers, Katelynn Peirce, and Anne M. Walling. "Assessing associations between symptoms and survivorship care plans among long-term cancer survivors." Journal of Clinical Oncology 33, no. 29_suppl (October 10, 2015): 246. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.246.

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246 Background: Nearly 14 million Americans are cancer survivors, and numbers are increasing. Common long-term and late effects reported by survivors include anxiety, depression, fatigue, pain, and others. In order to address potential long-term and late effects of cancer and its treatment, the IOM recommends that patients receive a Survivorship Care Plan (SCP), a record of care received and important disease characteristics and a follow-up care plan incorporating available evidence-based standards of care. Our aims were to assess prevalence of self-reported moderate-severe symptoms and worry, and test for associations with SCP receipt. Methods: We used data from CanCORS II, a national study of lung and colorectal cancer patients. Long term survivors were diagnosed in 2004, and showed no sign of disease seven years post-diagnosis. We included 888 lung and colorectal cancer survivor respondents to the CanCORS II Long Term Survivor Survey. We examined moderate-severe pain (3, 4, or 5 on the SF-36 pain interference item), fatigue (less than 40 on the SF-36 vitality score), depressive symptoms ( > 6 on CESD-8), and worry about recurrence. SCP receipt was defined as receipt of a treatment summary, follow-up care plan, or both. Multivariable logistic regression was used to test for associations between SCP and symptoms and worry. Results: In all, 27% of survivors had 0, and 26% had both SCP components. Moderate-severe pain was reported by 32% of colorectal and 42% of lung cancer survivors, and fatigue by 15% of colorectal and 30% of lung cancer survivors. Moderate-severe depressive symptoms were reported by 12% of colorectal cancer and 16% of lung cancer survivors. Less than ¼ (23%) reported worry about recurrence sometimes, often or always. In analyses adjusting for demographics and health status, receipt of both SCP components was associated with lower odds of moderate-severe pain (OR = 0.78, p = 0.004), fatigue OR = 0.42, p = 0.006), and depressive symptoms (OR = 0.48, p = 0.03). Conclusions: Receipt of a complete SCP was associated with lower odds of moderate-severe pain, fatigue, and depressive symptoms. We found no association with worry. However, only 26% of survivors reported receipt of both SCP components as recommended.

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Matulonis, U. A., A. Kornblith, H. Lee, J. Bryan, C. Gibson, C. Wells, J. Lee, L. Sullivan, and R. Penson. "Long-term adjustment of early-stage ovarian cancer survivors." International Journal of Gynecologic Cancer 18, no. 6 (2008): 1183–93. http://dx.doi.org/10.1111/j.1525-1438.2007.01167.x.

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The objectives of this study were to describe the quality of life (QOL), consequences of treatment, complementary therapy use, and factors correlating with psychologic state in 58 survivors of early-stage ovarian cancer since little is known about the QOL of early-stage ovarian cancer survivors. Survivors were interviewed using standardized measures to assess physical, psychologic, social, and sexual functioning; impact of cancer on socioeconomic status; and complementary therapy use. Survivors reported good physical QOL scores and few unmet needs. However, menopausal symptoms and negative impact on sexuality were reported. Less than 10% of survivors reported either an interest in sex or were sexually active. Psychologic assessment yielded a subset of 26% of patients with scores suggestive of posttraumatic stress disorder (PTSD) and 40% of survivors scored below the norm on the Mental Health Inventory-17 Survey. One third of patients required treatment for family/personal problems and took antianxiety medications. About 56% of survivors reported fear of cancer recurrence and 59% reported anxiety when their CA125 is tested. Better mental health was significantly related to less fatigue (Functional Assessment of Cancer Therapy [FACT]—fatigue, r= 0.61, P< 0.0001), less pain (European Organisation for Research and Treatment of Cancer [EORTC], r= −0.54, P< 0.0001), fewer stressful life events (Life Event Scale, r= −0.44, P> 0.001), and greater social support (MOS Social Support Survey, r= 0.41, P< 0.01). Early-stage ovarian cancer survivors had few physical complaints and unmet needs, but psychologic distress was evident in a subset of survivors; the majority of survivors reported sexual dysfunction. These results indicate the need for intervention and improved distress screening in the early-stage ovarian cancer population.

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Arrington, Amanda K., Leanne Goldstein, Laura Kruper, Courtney Vito, John Yim, and Steven L. Chen. "Life Expectancy after Curative-intent Treatment of Breast Cancer: Impact on Long-term Follow-up Care." American Surgeon 80, no. 6 (June 2014): 604–9. http://dx.doi.org/10.1177/000313481408000626.

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Long-term survival rates after treatment for breast cancer are directly influenced by early deaths resulting from disease. For longer-term breast cancer survivors, survival rates appear deceptively low. We hypothesize that the actual survival curve for long-term survivors approaches the overall survival of the general population. The Surveillance, Epidemiology, and End Results database (1988 to 2002) was used to identify patients with nonmetastatic breast cancer who underwent definitive surgical treatment. The survival of the general population was constructed by using national life tables with an age-matched population. Comparisons of survivals were made for 3-, 5-, and 7-year breast cancer survivor cohorts. Of 237,180 patients, 92.4 per cent survived three years, 82.1 per cent five years, and 58.1 per cent seven years. Stage I patients have equivalent or better survivals compared with the age-matched general population in all three cohorts. Stage II patients reached equivalent conditional survival between eight and nine years after diagnosis regardless of cohort. Stage III patients required achieving nine to 10 years after diagnosis to achieve equivalent survival probability, except in 7-year survivors, in whom 10 to 11 years was required. In all stages, once equivalence was reached, survival exceeded the general population over the remaining years. Initial cancer stage influences overall survival for many years after diagnosis. Patients with Stage I cancer return to the general population risk as early as three years after diagnosis, whereas higher stages can require up to nine years to achieve parity with a more generalized population. These findings should be factored into general health screening issues for long-term breast cancer survivors.

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Sullivan, Jeffrey, Julia Thornton Snider, Emma van Eijndhoven, Katharine Batt, Tony Okoro, Manan Shah, and Thomas DeLeire. "The well-being of long-term cancer survivors." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 30. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.30.

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30 Background: While numerous studies have examined the outcomes of individuals recently diagnosed with cancer, less is known about the well-being of long-term (LT) cancer survivors. Methods: Using the Health and Retirement Study (HRS), a nationally representative survey of US residents over age 50, we defined four cohorts: US residents over age 50, individuals recently diagnosed with cancer (≤4 years from diagnosis), LT cancer survivors (>4 years from diagnosis) and individuals with a chronic condition (diabetes, heart disease, hypertension, lung disease or prior stroke). We compared well-being measures across cohorts. We imputed total medical spending using the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey. Results: We identified 22,034 US residents over age 50; 754 individuals recently diagnosed with cancer; 1,764 LT survivors; and 12,874 individuals with chronic illness. Over the biannual survey waves from 2004-2012, this amounted to 22,034; 3,880; 8,480; and 57,363 person-years, respectively. (The 50+ cohort was analyzed in 2010, the most recent year in which the HRS was nationally representative.) Given the large samples, most differences between LT survivors and other cohorts were statistically significant (p<0.05). However, LT survivors’ outcomes were often closer to those of individuals with chronic illness than to the recently diagnosed. Earnings if employed of the recently diagnosed and self-reported health of the chronically ill were not significantly different from LT survivors. Conclusions: Although cancer has a negative impact on well-being in the short term, over time cancer survivors’ well-being improves, becoming more similar to that of individuals with a chronic condition. [Table: see text]

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Maass, Saskia W. M. C., Daan Brandenbarg, Liselotte M. Boerman, Peter F. M. Verhaak, Geertruida H. de Bock, and Annette J. Berendsen. "Fatigue among Long-Term Breast Cancer Survivors: A Controlled Cross-Sectional Study." Cancers 13, no. 6 (March 15, 2021): 1301. http://dx.doi.org/10.3390/cancers13061301.

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Background: Fatigue is the most common and persistent symptom among women in the first five years after a breast cancer diagnosis. However, long-term prevalence of fatigue, among breast cancer survivors, needs further investigation. Aim: To compare fatigue experienced by long-term breast cancer survivors with that in a reference population and to evaluate the determinants of that fatigue. Design and Setting: A cross-sectional cohort study of 350 breast cancer survivors ≥5 years after diagnosis and a reference population of 350 women matched by age and general practitioner. Method: Fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and a sum score of >60 (multidimensional fatigue) was the primary outcome. Logistic regression was applied to compare the prevalence of multidimensional fatigue between the survivor and reference populations, adjusted for body mass index (BMI) and for cardiovascular and psychological variables. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated. Logistic regression was applied to evaluate the determinants of multidimensional fatigue among the survivors. Results: Breast cancer survivors (median 10 years after diagnosis), more often experienced multidimensional fatigue than the reference population (26.6% versus 15.4%; OR, 2.0 [95%CI, 1.4–2.9]), even after adjusting for confounders. The odds of multidimensional fatigue were also higher among survivors with symptoms of depression (32.2% versus 2.7%; OR, 17.0 [95%CI, 7.1–40.5]) or anxiety (41.9% versus 10.1%; OR, 6.4 [95%CI, 3.6–11.4]). Conclusion: One in four breast cancer survivors experience multidimensional fatigue and fatigue occurs more frequently than in women of the same age and general practitioner. This fatigue appears to be associated with symptoms of depression and anxiety.

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&NA;. "Childhood cancer survivors have long-term morbidity." Reactions Weekly &NA;, no. 1124 (October 2006): 1. http://dx.doi.org/10.2165/00128415-200611240-00001.

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Kennedy, Maureen Shawn. "The Needs of Long-Term Cancer Survivors." AJN, American Journal of Nursing 105, no. 9 (September 2005): 30. http://dx.doi.org/10.1097/00000446-200509000-00021.

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&NA;. "Long-Term Follow-up of Cancer Survivors." Journal of Pediatric Hematology/Oncology 21, no. 6 (November 1999): 463–64. http://dx.doi.org/10.1097/00043426-199911000-00003.

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Janssen-Heijnen, M. L. G., S. Houterman, V. E. P. P. Lemmens, H. Brenner, E. W. Steyerberg, and J. W. W. Coebergh. "Prognosis for long-term survivors of cancer." Annals of Oncology 18, no. 8 (August 2007): 1408–13. http://dx.doi.org/10.1093/annonc/mdm127.

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Palos, Guadalupe R., Katherine Ramsey Gilmore, Patricia Chapman, Weiqi Bi, Delrose Jones, and Maria Alma Rodriguez. "Surveillance of long-term colorectal cancer survivors." Journal of Clinical Oncology 33, no. 15_suppl (May 20, 2015): e20596-e20596. http://dx.doi.org/10.1200/jco.2015.33.15_suppl.e20596.

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Nelson, Roxanne. "Childhood cancer survivors face long-term complications." Lancet 362, no. 9387 (September 2003): 884. http://dx.doi.org/10.1016/s0140-6736(03)14356-5.

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wonden, J. C. van der, J. G. W. Greavew-otte, J. Greaves, Ph M. Kruyt, O. van Leeuwen, and E. van der Does. "Occupational Reintegration of Long- Term Cancer Survivors." Journal of Occupational and Environmental Medicine 34, no. 11 (November 1992): 1084–89. http://dx.doi.org/10.1097/00043764-199211000-00010.

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&NA;. "Childhood cancer survivors have long-term morbidity." Inpharma Weekly &NA;, no. 1560 (October 2006): 22. http://dx.doi.org/10.2165/00128413-200615600-00058.

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Bradley, Cathy J., and Heather L. Bednarek. "Employment patterns of long-term cancer survivors." Psycho-Oncology 11, no. 3 (2002): 188–98. http://dx.doi.org/10.1002/pon.544.

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Barbera, Lisa Catherine, Rinku Sutradhar, Doris Howell, Deborah Dudgeon, Hsien Seow, Mary Ann O'Brien, Clare Atzema, et al. "Opioid use in long term cancer survivors." Journal of Clinical Oncology 36, no. 15_suppl (May 20, 2018): 6520. http://dx.doi.org/10.1200/jco.2018.36.15_suppl.6520.

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Galassi, Annette. "Primary Care of Long-term Cancer Survivors." Nurse Practitioner 24, Supplement (November 1999): 7. http://dx.doi.org/10.1097/00006205-199911001-00018.

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Halstead, Marilyn Tuls, and Jayne I. Fernsler. "Coping strategies of long-term cancer survivors." Cancer Nursing 17, no. 2 (April 1994): 94???100. http://dx.doi.org/10.1097/00002820-199404000-00003.

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Simonelli, Cecilia, Massimiliano Berretta, Umberto Tirelli, and Maria A. Annunziata. "Clinical Management of Long-Term Cancer Survivors." Journal of Clinical Oncology 26, no. 1 (January 1, 2008): 161–62. http://dx.doi.org/10.1200/jco.2007.14.7694.

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Patanè, Salvatore. "Cardiotoxicity: Cisplatin and long-term cancer survivors." International Journal of Cardiology 175, no. 1 (July 2014): 201–2. http://dx.doi.org/10.1016/j.ijcard.2014.04.238.

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Patanè, Salvatore. "Cardiotoxicity: Anthracyclines and long term cancer survivors." International Journal of Cardiology 176, no. 3 (October 2014): 1326–28. http://dx.doi.org/10.1016/j.ijcard.2014.07.149.

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Swetter, Susan M., Arianna Aldridge Gerry, Kelly Bugos, Ralph Steven Greco, Katherine L. McGurk, and Oxana Palesh. "Health behaviors and survivorship needs of short- versus long-term melanoma survivors." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 9061. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.9061.

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9061 Background: Little is known about melanoma survivors and their long-term symptoms, sun protection practices and support needs from health professionals. Methods: Melanoma survivors previously treated at Stanford Cancer Center completed a quality improvement survey to explore the value of a melanoma survivorship clinic, as part of the Stanford Cancer Survivorship Program. The survey period ranged from July 2012 to September 2012, and 17% of the 893 invited survivors responded. We compared responses of melanoma survivors diagnosed between 2006-2011 (short-term) and 1995-2005 (long-term). Results: 153 cancer survivors (41% short- and 59% long-term) completed the survey. On average, they were 62 years of age (SD=15.1), 94% Caucasian, 47% female, and 68% underwent local excision alone. Long- vs. short-term survivors were less likely to receive routine skin screening every 3-6 months (38% vs. 83%, p<0.001) or follow-up for their melanoma in the last 6 months (54% vs. 76% p=0.045). Sun protection practices were similar between groups; however, long-term survivors decreased their use of tanning beds (33% vs. 18%, p=0.03) and time seeking a tan relative to short-term survivors (72% vs. 48%, p=0.002). Overall, survivors rated anxiety as the most prevalent symptom (33%), followed by numbness of the scar site (31%), forgetfulness (26%), sleep problems and depression (23%), pain and fatigue (17%). Sixty-eight percent of all survivors reported their symptoms were not addressed by their health provider, and of those stating their provider addressed their symptoms (32%), the survivor initiated the conversation 71% of the time. In general, survivors desired education about the long-term effects of melanoma (41%), family risk of skin cancer (28%), and protecting their skin from further damage (20%). Twenty percent of all survivors requested treatment for the long term effects of melanoma, and 12% wanted emotional support. Conclusions: Melanoma survivors experience continuing symptoms long after treatment, namely anxiety, and express a need for information about long-term melanoma effects, psychosocial support, and prevention of further skin cancer. Clinicians should routinely assess survivorship needs to improve quality of life.

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Xie, Wanling, Toni K. Choueiri, Jae-Lyun Lee, Lauren Christine Harshman, Georg A. Bjarnason, Jennifer J. Knox, Mary J. MacKenzie, et al. "Characteristics of long-term and short-term survivors of metastatic renal cell carcinoma (mRCC) treated with targeted therapy: Results from the International mRCC Database Consortium." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 4538. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.4538.

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4538 Background: Patients with mRCC have variable courses in terms of survival and response to targeted therapy. The patients at the two extremes of the survival spectrum need to be characterized. Methods: 2,161 patients with mRCC treated with targeted therapy were examined. 152 patients who survived 4 years or more after the initiation of targeted therapy (long-term) were compared with 218 patients who survived 6 months or less (short-term) over the same time period (2004-2007). Results: Long-term survivors had fewer poor prognostic factors (PFs) such as Karnofsky performance status (KPS) <80%, diagnosis to treatment interval<1 yr, hypercalcemia, anemia, thrombocytosis and neutrophilia (all p<0.0001). Patients with favorable prognosis who responded to targeted therapy were more likely to be long term survivors. For those in the intermediate risk group, patients who were long-term survivors were more likely to have only 1 poor prognostic factor (73% vs. 28%, p<0.0001) and KPS≥80% (88% vs. 69%, p=0.009) compared to those in the short term survivor group. On multivariable analysis adjusting for PFs, response to targeted therapy (PR or better) significantly predicted long term survivor status (odds ratio=6.3, 95% CI: 2.3,17.4, p=0.0004). Conclusions: Long term survivors had a higher response rate to targeted therapy, a longer treatment duration and more use of second-line targeted therapy. Baseline prognostic criteria may be able to discriminate between long- and short- term survivors. [Table: see text]

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Maunsell, Elizabeth, Lisa Pogany, Maru Barrera, Amanda K. Shaw, and Kathy N. Speechley. "Quality of Life Among Long-Term Adolescent and Adult Survivors of Childhood Cancer." Journal of Clinical Oncology 24, no. 16 (June 1, 2006): 2527–35. http://dx.doi.org/10.1200/jco.2005.03.9297.

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Purpose We assessed effects of childhood or adolescent cancer on quality of life among adolescent and adult cancer survivors, a group who are thought to be at particular risk for adverse late effects. Patients and Methods We studied 1,334 survivors and 1,477 age- and sex-matched, general population controls from across Canada using a mailed questionnaire which included the Short Form-36 (SF-36) and measures of self-esteem, optimism, and life satisfaction. General linear models and logistic regression were used. Survivor-control differences corresponding to an effect size (ES) ≥ 0.5 were considered clinically important. Results Participants were age 15 years to 37 years. Most survivors (83.8%) were diagnosed ≥ 10 years earlier. Fewer survivors (62.1%) than controls (71.1%) reported very good or excellent general health (adjusted odds ratio, 0.6; 95% CI, 0.5 to 0.7). However, quality of life differences between survivors and controls were small, and for the most part probably not clinically important. Three clinical characteristics—having had CNS or bone cancer, more than one treatment series, and ≥ two organs with a dysfunction at treatment end—were independently associated with poorer quality of life in the physical dimensions. Only survivors with ≥ two organs with dysfunction (8.7%) reported poorer quality of life in both physical and psychosocial domains, with several clinically important ES. The largest ES for the SF-36 physical summary scores were found in the 8% of survivors with two or three of these characteristics simultaneously, compared with those survivors who had none (−0.79 and −1.13, respectively). Conclusion Overall, a sizeable majority of adolescent and adult long-term survivors of childhood cancer in Canada appear to have adapted well.

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Lassmann, Irène, Andreas Dinkel, Birgitt Marten-Mittag, Matthias Jahnen, Helga Schulwitz, Jürgen E. Gschwend, and Kathleen Herkommer. "Benefit finding in long-term prostate cancer survivors." Supportive Care in Cancer 29, no. 8 (January 15, 2021): 4451–60. http://dx.doi.org/10.1007/s00520-020-05971-3.

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Abstract Purpose Benefit finding (BF) represents possible positive changes that people may experience after cancer diagnosis and treatment and has proven to be valuable to the psychological outcome. Knowledge of such beneficial consequences of prostate cancer (PCa) is limited in long-term survivors (> 5 years). Thus, the present study investigated the occurrence of benefit finding (BF) and its determinants in a large sample of (very-) long-term PCa survivors. Methods BF was assessed in 4252 PCa survivors from the German database “Familial Prostate Cancer” using the German version of the Benefit Finding Scale (BFS). Associations between BF and sociodemographic, clinical, and psychosocial (e.g., depressive and anxiety symptoms and perceived severity of the disease experience) variables were analyzed using hierarchical multiple linear regression analysis. Results Mean age at survey was 77.4 years (SD = 6.2) after a mean follow-up of 14.8 years (SD = 3.8). Mean BFS score was 3.14 (SD = 1.0); the prevalence of moderate-to-high BF (score ≥ 3) was 59.7%. Younger age at diagnosis, lower educational level, and higher perceived severity of the disease experience were predictive of BF. Objective disease severity or family history of PCa was not uniquely associated with BF. Conclusions BF occurs in older, (very-) long-term PCa survivors. Our findings suggest that the self-asserted severity of the disease experience in a patient’s biography is linked to BF in the survivorship course above all tangible sociodemographic and clinical factors. Implications for cancer survivors PCa survivors may express BF regardless of clinical disease severity. Treating urologists should consider inquiring BF to enrich a patient’s cancer narrative.

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Woopen, Hannah, Carolin Rolf, Elena Ioana Braicu, Nina Buttmann-Schweiger, Benjamin Barnes, Joanna Baum, Klaus Pietzner, Klaus Kraywinkel, and Jalid Sehouli. "Secondary malignancies in long-term ovarian cancer survivors: results of the ‘Carolin meets HANNA’ study." International Journal of Gynecologic Cancer 31, no. 5 (March 1, 2021): 709–12. http://dx.doi.org/10.1136/ijgc-2020-002155.

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ObjectiveTo evaluate the rate of secondary malignancies in long-term survivors with ovarian cancer.MethodsLong-term survivors with ovarian cancer (survival ≥8 years after initial diagnosis) with multiple malignancies were identified within the Tumorbank Ovarian Cancer and our study ‘Carolin meets HANNA – Holistic Analyses of Long-term Survivors with Ovarian Cancer’.ResultsOf a total of 225 long-term survivors with ovarian cancer, 36 patients (16%) had at least one more cancer diagnosis before, concomitant with, or after, ovarian cancer. Median age was 52.5 years (range 37–79). A total of 60% were diagnosed with stage III/IV and most tumors were high-grade (88.6%), as well as of serous histology (63.9%). Median overall survival was 10 years (range 8–19). Secondary cancer after ovarian cancer was found in 17 long-term survivors (7.6%). Breast cancer was the most frequent secondary malignancy. Median duration between diagnosis of primary ovarian cancer and secondary cancer diagnosis was 78.5 months (range 12–220). BRCA was tested in 11 patients with seven patients being BRCA1 and one patient BRCA2 positive. Secondary cancers were detected by screening in 35.3% and self-detected in 29.4% of patients (breast self-examination).ConclusionA secondary malignancy was diagnosed in 7.6% of long-term survivors. Routine follow-up and cancer screening should be performed in long-term ovarian cancer survivors.

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Shin, Woo-kyoung, Sihan Song, Eunkyung Hwang, Hyeong-Gon Moon, Dong-Young Noh, and Jung Eun Lee. "Development of a FFQ for breast cancer survivors in Korea." British Journal of Nutrition 116, no. 10 (November 15, 2016): 1781–86. http://dx.doi.org/10.1017/s000711451600372x.

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AbstractDiet may play an important role in breast cancer recurrence or survival, and therefore assessment of long-term diet among breast cancer survivors is important in breast cancer survivorship research. Given that the diet of breast cancer survivors may differ from that of the general population, the use of a FFQ specific to this group may be needed. The objective of this study was to develop a FFQ for breast cancer survivors, the most commonly used tool to measure long-term dietary patterns in nutritional epidemiological studies. We collected information on the foods and amounts of foods consumed using 3-d dietary records from a total of 192 women who had been diagnosed with stage I–III breast cancers and had undergone breast cancer surgery at least 6 months before the baseline study. A total of 1254 foods and dishes consumed were re-grouped by the similarity of the main ingredients and/or serving units, and several dishes commonly consumed among the Korean population were added. After we performed contribution analyses and variability analyses to detect between-person variation for selected nutrients, we listed a total of 123 foods and dishes for the FFQ specific to breast cancer survivors. Our breast cancer survivor-specific FFQ can be used to estimate long-term dietary intake and to examine its association with breast cancer prognosis in epidemiological studies of breast cancer in Korea.

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Miller, T. L., A. M. Miller, G. Lopez-Mitnik, G. Somarriba, S. R. Lipsitz, A. S. Hinkle, L. S. Constine, and S. E. Lipshultz. "Exercise capacity in long-term survivors of pediatric cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 10026. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.10026.

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10026 Background: Childhood cancer survivors may have premature symptomatic cardiovascular and noncardiovascular diseases that contribute to reduced capacity for physical activity. Controlled assessments of exercise capacity and identification of risk factors for reduced capacity in survivors are lacking. Methods: We assessed maximal myocardial oxygen consumption (VO2max; measure of exercise capacity) in survivors at least 4 years after diagnosis and sibling controls. We evaluated associations between VO2max and age, sex, treatments, cardiac structure and function, biomarkers, endocrine function, and physical activity. Results: Of 72 survivors (mean age, 22 y; range, 8.0 to 40 y) and 32 siblings (mean age, 20.2 y; range, 8 to 46 y), about half were male. The mean time since cancer diagnosis was 13.4 y (range, 4.5 to 31.6 y). In age- and sibling-pair adjusted analyses, VO2max was lower in survivors than siblings (males, 28.53 vs. 30.90 mL/kg/min, P = 0.08; females, 19.81 vs. 23.40 mL/kg/min, P = 0.03). In male survivors, older age (P = 0.01), higher percent body fat (P < 0.001) and high or low left ventricular (LV) mass Z-scores (P = 0.03) predicted lower VO2max. In females, older age (P < 0.001), methotrexate exposure (P = 0.01), and higher, but normal, LV load-dependent contractility (P = 0.02) predicted lower VO2max. Conclusions: Physical fitness for most participants in each group was poor, and was generally lower in survivors, particularly females. Older age, higher body fat, methotrexate exposure, and extremes of LV mass/function were associated with lower VO2max in survivors. Because physical activity can improve nutritional and cardiac conditions, survivors should be encouraged to engage in regular exercise with close medical monitoring. No significant financial relationships to disclose.

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Gallicchio, Lisa, Emily Tonorezos, Janet S. de Moor, Joanne Elena, Margaret Farrell, Paige Green, Sandra A. Mitchell, et al. "Evidence Gaps in Cancer Survivorship Care: A Report From the 2019 National Cancer Institute Cancer Survivorship Workshop." JNCI: Journal of the National Cancer Institute 113, no. 9 (March 23, 2021): 1136–42. http://dx.doi.org/10.1093/jnci/djab049.

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Abstract Today, there are more than 16.9 million cancer survivors in the United States; this number is projected to grow to 22.2 million by 2030. Although much progress has been made in describing cancer survivors’ needs and in improving survivorship care since the seminal 2006 Institute of Medicine report “From Cancer Patient to Cancer Survivor: Lost in Transition,” there is a need to identify evidence gaps and research priorities pertaining to cancer survivorship. Thus, in April 2019, the National Cancer Institute convened grant-funded extramural cancer survivorship researchers, representatives of professional organizations, cancer survivors, and advocates for a 1-day in-person meeting. At this meeting, and in a subsequent webinar aimed at soliciting input from the wider survivorship community, evidence gaps and ideas for next steps in the following 6 areas, identified from the 2006 Institute of Medicine report, were discussed: surveillance for recurrence and new cancers, management of long-term and late physical effects, management of long-term and late psychosocial effects, health promotion, care coordination, and financial hardship. Identified evidence gaps and next steps across the areas included the need to understand and address disparities among cancer survivors, to conduct longitudinal studies as well as longer-term (>5 years postdiagnosis) follow-up studies, to leverage existing data, and to incorporate implementation science strategies to translate findings into practice. Designing studies to address these broad evidence gaps, as well as those identified in each area, will expand our understanding of cancer survivors’ diverse needs, ultimately leading to the development and delivery of more comprehensive evidence-based quality care.

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Korszun, Ania, Shah-Jalal Sarker, Kashfia Chowdhury, Charlotte Clark, Paul Greaves, Rachel Johnson, Judith Kingston, et al. "Psychosocial Factors and Impact Of Cancer In British Long-Term Haematological Cancer Survivors." Blood 122, no. 21 (November 15, 2013): 2943. http://dx.doi.org/10.1182/blood.v122.21.2943.2943.

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Abstract Background Long-term cancer survivors can experience a variety of adverse physical late effects of cancer therapy. However, psychological, e.g. depression and anxiety, and social problems can also have profoundly adverse effects on patients’ quality of life (QOL) that may not be adequately addressed in the management of long-term survivors. This study examines the effect and interaction of several disease-related, social and psychological factors on QOL in 718 British long-term haematological cancer survivors (5-40 years), who had all been treated at a single centre over 50 years. Objectives (1) to measure the prevalence of psychological distress (depression, anxiety), functioning, and fatigue in this survivor group compared to rates in the UK population and other survivor groups, (2) to investigate the effect of cancer and cancer treatment on QOL and psychological and social functioning, (3) to identify psychosocial factors associated with poorer QOL outcome. Patients and Methods Ethical approval obtained from the National Research Ethics Service Ref: 11/NE/0095 All patients, aged ≥18 years at time of entry into study, with a confirmed diagnosis of haematological malignancy and alive ≥5 years since initial diagnosis, and who had received treatment at St. Bartholomew’s Hospital, London (n=1,279) were sent a questionnaire comprising questions on physical health and validated psychosocial, functional and QOL scales, including negative and positive impact of cancer (IOC). Responses were received from 718 (response rate = 56%) patients (280 Hodgkin’s Lymphoma (HL), 326 Non-Hodgkin’s lymphoma (NHL) [109 Diffuse Large B- Lymphoma (DLBCL), 128 Follicular Lymphoma (FL), 89 other NHL (ONHL)], and 112 Acute Leukaemia (AL)). Statistical Analysis QOL measures were compared to normal population and other cancer survivor groups. Two separate hierarchical regression analyses were conducted to examine the combined association of the disease type, socio-demographics, psychological and other factors, including cancer recurrence, on negative and positive IOC scores respectively. Results Survivors had poorer QOL than the general population and 15% had levels of psychological distress indicative of a clinical depressive disorder, 18% high levels of fatigue and 10% moderate to severe impairment in functioning; all these groups showed poorer QOL. There were no statistically significant differences in psychological distress (P=0.76), fatigue levels (P=0.23) or levels of functioning (P=0.74) across different cancer diagnostic groups. Higher Negative IOC scores were significantly associated (P<0.001) with the presence of medical comorbidity, depression, low or medium level of social support, a high level of fatigue and functional impairment. Greater age at diagnosis and number of years since diagnosis were significantly (P<0.001) associated with less negative IOC. Higher positive impact scores were associated with an AL diagnosis (P=0.01) ; lower positive IOC scores were associated with white ethnicity (P<0.001), a high level of education (P=0.003), not having a partner (P=0.01), depression(P=0.04), and a low level of social support (P=0.01). Conclusion The impact of cancer on survivors’ lives is influenced by a variety of factors. By using a simple means of screening for medical comorbidity, depression and fatigue the group that needs most support could be identified early, allowing appropriate interventions to improve QOL-related measures and promote well-being by addressing both negative and positive impact of cancer. Acknowledgments We are grateful for the support of Macmillan Cancer Support Greg Woolf Foundation Cancer Research UK Barts and The London NHS Trust Disclosures: No relevant conflicts of interest to declare.

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Sarna, Linda, Geraldine Padilla, Carmack Holmes, Donald Tashkin, Mary Lynn Brecht, and Lorraine Evangelista. "Quality of Life of Long-Term Survivors of Non–Small-Cell Lung Cancer." Journal of Clinical Oncology 20, no. 13 (July 1, 2002): 2920–29. http://dx.doi.org/10.1200/jco.2002.09.045.

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PURPOSE: To describe the quality of life (QOL) among survivors of non–small-cell lung cancer (NSCLC).PATIENTS AND METHODS: One hundred forty-two 5-year minimum self-reported disease-free survivors of NSCLC completed QOL instruments (QOL-Survivor and Medical Outcomes Study 36-Item Short Form [SF-36]) and assessments of emotional distress (Center for Epidemiologic Studies Depression Scale [CES-D]), comorbid disease, and tobacco use. Pulmonary function was assessed with a hand-held spirometer. Multivariate regression methods were used on total QOL-Survivor scores and physical (PC) and mental (MC) component scores of the SF-36.RESULTS: The majority (71%) of survivors described themselves as hopeful, and 50% viewed the cancer experience as contributing to positive life changes (QOL-Survivor). Comorbidity was common (60% ≥ one condition); 22% had distressed mood (CES-D ≥ 16). Most were former smokers (76%); 13% continued to smoke. Half had moderate/severe pulmonary distress (forced expired volume in 1 second [FEV1] < 70% of predicted). Regression models including the set of variables (age, sex, living alone, education, smoking status, pulmonary function category, distressed mood, time since diagnosis, and comorbidity) accounted for 37%, 48%, and 29% in the QOL-total, MC, and PC scores, respectively. Primary predictors of lower QOL scores were white ethnicity and distressed mood (CES-D ≥ 16) (34% of the variance explained). The primary predictor of lower MC scores was distressed mood (R2= 0.45). Lower PC scores were associated with older age, living alone, FEV1less than 70% of predicted, distressed mood, time since diagnosis, and more comorbid diseases (R2= 0.28).CONCLUSION: These findings provide the first description of the QOL of long-term survivors of lung cancer. Risk factors for poorer QOL are strongly linked to distressed mood, which is a potential target for intervention.

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